It is readily acknowledged that medical services billing and insurance coverage is a complex path to walk. It should be clear what is covered by insurance and what is not, but not only is this difficult for the insured, it is also often unexplainable to the physicians billing services. The physician’s visit is allowable but certain tests are not fully covered. The drugs prescribed are sometimes fully covered and sometimes not. A doctor can be dropped from insurance coverage, though they have been for the last ten years. Though they are required to tell all the persons involved, this information can disappear in the mountains of paperwork, leaving the bewildered physicians and their clients to try to figure out the amounts owed.
Clay had been seeing his doctor for five years. diminish the symptoms of asthma. Albuterol, an inhaler for short-term symptoms was used. When his breathing difficulties increased, another steroid breather, Advair was added. When surprised by a severe asthma attack, he had to go to the emergency room for treatment. All of this was, as usual, completely covered by Clay’s insurance. Two months later when Clay returned to his doctor for a check-up and to get his prescription refilled, Clay was taken aback when the pharmacist told him that the Advair he needed in order to breathe was now going to cost him one hundred dollars every two months.
When Clay called his insurance provider, he was told that Advair was no longer covered under his plan. He he explained that the other medicines didn’t work. The insurance company provided no solutions. This was the responsibility of physician and patient.
Three months later, Clay also received a bill for the entire payment of his treatment and lab tests at the previous doctor’s visit. He phoned the billing office of the doctor and was informed that his primary care practitioner was also no longer covered under his insurance. When he called the insurance company to complain, their response was that doctors were shifted from time to time and it was up to the medical provider to let you know your required payment at the time of the visit. When Clay called the billing office he was told, that because he was a continuing client, payment was not required immediately, but as a courtesy, sent him a bill in the mail.
Clay struggled with the insurance provider for years with no result. In the interim, he acquired a bad credit rating because his bill went to collections since he refused to pay it.. The doctor also went unpaid for Clay’s visit, as well as losing a valuable client. Extra phone time and paperwork was required by the billing company, not to mention the stress of dealing with a disgruntled patient. The ones who didn’t suffer were the ones who understood exactly what was going on and that was the insurance company.
